2020, Volume 6 Issue 2
Spinal Tuberculosis: Its clinical presentation, management and outcome - A retrospective study
Author(s): Nishat Setia, Kanish Kinra, Divya Bansal and Neha Setia
Abstract: Tuberculosis (TB) of the spine (Pott’s disease) is the most common skeletal form of TB infection. In India, Pott’s disease remains a serious problem, causing paraplegia. It should be considered when patients present with neurological findings suggesting of cord compression and spinal deformity, delay in establishing diagnosis and management cause spinal cord compression causing neurological impairment and kyphotic spinal deformity. In this retrospective study, we report our experience with the management of 20 patients with Pott's disease in the past 2 years. The mean patient age was 40 years. Nine (45%) were men, nine (45%) were women and Two (10%) children, both female. Nineteen (95%) had a positive tuberculin skin test, and Six (30%) had pulmonary tuberculosis. Symptoms consisted of pain, motor weakness, fever, sensory complaints, and flank mass in order of decreasing frequency. Two patients were neurologically intact; the remainder had motor deficits of variable severity. Isolated cervical spine was involved in 2 (10%) patients, isolated dorsal spine was involved in 7 (35%) patients, isolated lumbar spine was involved in 5 (25%) patients, the thoraco-lumbar spine was involved in 5 (25%) patients and the lumbo-sacral spine was involved in 1(5%) patient. Spinal deformity was present in 8 patients, spinal epidural compression was present in 13 patients, and a paraspinal mass was present in 16 patients. Operative indications included motor deficits, non-diagnostic computer tomographic-guided needle biopsy, and non-compliance with, or lack of response to medical therapy. Eight patients underwent operation, seven had antero-lateral decompression done with paraspinal abscess drainage & one had laminectomy assisted decompression. Patients have been monitored periodically and almost all have neurologically improved or normalized without residual infection. In the present study, it was concluded that early initiation of Anti Tubercular Therapy along with early operative decompression in selected patients, when indicated, minimizes neurological deterioration and spinal deformity, results in early mobilization and excellent neurological outcome of the patients.
